Discharging from belly wound after J-pouch surgery: Normal or surgical error?

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vasile
After 12 years of suffering with UC, I've decided to go for a J-pouch 3-step surgery.

Dr. Luca Stocchi @ Cleveland Clinic did my first surgery 2-3 weeks ago. I stayed in the hospital for 2.5 days, then had a 9-hour ride back home. I had a colectomy and was left with a short stump from the anus to the open wound on my belly. I believe he said that he had stapled this end inside my tummy. A week later, one morning I had a bad feeling that I needed to go and discharge the contents of my rectum. It was painful as it used to be, but all I've seen was old blood and some new blood. The doctor told me this would happen and not to panic. I used a Canasa suppository hoping that it would calm down my flare, but to my surprise, this suppository showed up in chunks discharging from my belly wound. Is this normal?

Does anyone know how long it will take for the open surgical wound below my belly button to heal? Should this even be open? Could this be a surgical error, missing some stitches or some got loose? Can I use any tea enemas to keep the leftover colon clean?

The doctor emailed me back, telling me not to worry.
Primeboy

Your surgical wound should not be open. About 7 days after my surgery, my nurse called a code practically when she found that my post-operative wound had ruptured. A medical intern had removed my staples, did a little sewing and applied bandages; but an hour later all the stitches popped. Don't play around with home remedies. Go to a nearby emergency room and get a competent surgeon to close the wound securely. Don't mess around with possible infections.

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scotiaman

Prime boy is absolutely right on, open would can easily get infected, as well, a small wound can lead to it opening further. I had a 5 in. abdominal incision open 75%, it can't be stitched or stapled second time around. In addition, open wounds heal from the bottom up and that is a complicated process involving special wound care...it took from mid-March to end of July for me to heal...see a surgeon, you may need some special wound care which involves daily dressing changes. Good luck.

vasile

Thank you both Primeboy and Scotiaman, for your advice. I did go a week ago to my family practice doctor where they have a pretty well-equipped special procedure equipment, but the doctor placed some tapes and told me it is too late for stitches? Tapes lasted only one day due to bleeding. I have decided to go first of next week to see my surgeon in Cleveland, an 8-9 hour drive one way. I will update this blog as soon as I return from Cleveland Clinic.

scotiaman

Vasile, a couple of comments...knowing what I know of how these operations are performed, I can't imagine how suppository chucks can be coming through an abdominal incision, at least that's how I read it. The rectal stump is closed off inside, and a suppository must discharge through the anus. That said, if the incision is the main concern, you might call your surgeon's office and see if he could refer you to a wound nurse or specialist closer to home. Make sure you keep the incision really clean. You would get sterile dressings at the drug store and tape to keep it well covered. The dressings should be changed every 24 hours, at least until you get professional advice. If you see pus around the wound, I would advise going to an emergency department at a hospital. You do NOT want to get it infected. Good luck.

 
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Primeboy

PS: I hope you are on a strong course of antibiotics, Vasile.

vasile

I wish I would have some antibiotics but I do not. I do change my dressing 3-4 times a day. I had to use some of my wife's feminine pads due to so much blood. So far all is clean, no foul smell and no fever. However, I feel a lot of pain especially when I need to empty this colon stump once or twice a day. The only way I can calm it down is if I sit in hot water in the bathtub.

Primeboy

Vasile, Cleveland Clinic accepts you if there is a reasonably good chance of success. I am seeing just the opposite in your words. See if a second doctor and direct your case. It might just save your life. PB

Primeboy

Sorry, that is, if a second doctor can direct your case.

vasile
Thank you, Primeboy. I know that it is critical, and I have tried to get another surgeon to see me, but they do not see patients only one day a week. I will set up an appointment with a different surgeon a week from Wednesday. My scheduled post-op visit is this Tuesday afternoon at Cleveland Clinic. (Maybe the doctor is right, this is how he deals with the type of Ulcerative Colitis I am having, as a long scope the pouch??? I just do not know.) I have now got some Flagyl and Amoxicillin, but I am afraid to take it without the doctor's approval. I will take it easy and rest and hope for the best.
Primeboy

My doctor does not go crazy when he finds that I am taking stuff before he actually authorized it. Old folks have a way to build their own pharmacies over the years by saving a few pills here and there. When he finds out about our rationale for doing so and inquires about the patient responses, sometimes he'll advise one of us to continue. Other times to discontinue. He avoids being judgmental. He is more interested in patient improvement than in patient control. He wants us to be active in our treatment. Doctors like this will save lives.

vasile

Hello all and thanks for your support.
I did see Dr. Luca Stocchi and he explained very well what he has done.
Due to the fact that I have been on Prednisone for the last 9 months, he proceeded with a 3-step J-pouch procedure. The leftover stump was brought and sewed to inside my skin, allowing any drainage from my existing ulcers to drain out through the 1.5-inch incision below my belly button.
If they would have closed the wound, the drainage would have gone inside me and caused an infection.
He told me to use the Canasa suppository and not to worry if it comes out through my incision.
Once the butter-like medicine comes out, it will harden in small chunks and this is normal.
He said that the healing of my leftover stump may take some time. They have some nice sponge with silicone wafer adhesive for this kind of wounds and it works great, but I have to change it quite often.
I am back to work since I do not have any more FMLA for now, but just 38 hours.
In the next coming months, I will get some more FMLA days and hope all will be OK for my next surgery. Step 2 (I believe this will be the most difficult one)

I hope this answer will help others understand the process.

"Love one another"
Vasile

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